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Reimbursement Affects Cataract Surgery Rates, Costs

Study finds lower extraction rates and costs under contact capitation than with fee-for-service

TUESDAY, Dec. 13 (HealthDay News) -- Compared with fee-for-service, contact capitation reimbursement is associated with significant decreases in cataract extraction rates and costs, according to a study published in the December issue of the Archives of Ophthalmology.

William Shrank, M.D., of the Veterans Affairs Greater Los Angeles Health Care System in California, and colleagues analyzed data on 91,473 commercial beneficiaries and 14,084 Medicare beneficiaries who received eye care from a network of ophthalmologists and optometrists in St. Louis between 1997 and 1998. They compared the rate of cataract extractions per 1,000 beneficiaries, the costs of cataract procedures, the rates of non-cataract procedures, and the level of professional reimbursement for providers during the first six months of contact capitation and the final six months of fee-for-service physician reimbursement.

The researchers found that commercial and Medicare beneficiaries were half as likely to undergo cataract extraction under contact capitation as compared with fee-for-service. Under contact capitation, the researchers also found that physician reimbursement rates increased by 8% and that facility fees for cataract surgery decreased by about 45%.

"The finding that cataract surgery was more responsive to reimbursement methodology than other procedures supports the hypothesis that elective procedures are more responsive to physician incentives than non-elective procedures," the authors conclude. "More study is needed to evaluate the relationship between costs, quality and combinations of physician reimbursement incentives and methodologies."

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